Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and/or inattention. ADHD is chronic, may persist into adulthood, and is associated with impairment in social and academic/work domains across the lifespan. Children and adolescents with ADHD often present with executive function deficits and emotion dysregulation, and these deficits may increase impairment and risk for co-occurring disorders. The etiology of ADHD is not yet understood, though research suggests that biological and environmental factors (e.g., family, community) contribute to its development and course. It should be noted that ADHD commonly co-occurs with additional psychiatric disorders, such as oppositional defiant disorder (ODD), conduct disorder (CD), and major depressive disorder.
Evidence-based assessment of ADHD requires information from multiple informants using multiple assessment methods to determine the presence of ADHD symptoms across settings and any co-occurring disorders. The evidence-based treatment options for ADHD are manifold. Pharmacotherapy for ADHD is common, although numerous behavioral interventions are also effective. Stimulant medications are commonly prescribed and are typically effective in ameliorating core ADHD symptoms. There is also evidence that the nonstimulant medication atomoxetine substantially decreases the symptoms of ADHD. Importantly, medication therapy works to reduce symptoms but typically does not alleviate the impairments associated with the disorder. Combined medication and behavioral interventions are more likely to reduce impairments and normalize behavior.
Article
ADHD in Children and Adolescents
Kelsey E. Woods, Christina M. Danko, and Andrea Chronis-Tuscano
Article
Anxiety Disorders in Late Life
Jonathan S. Gooblar and Sherry A. Beaudreau
Anxiety disorders are among the most prevalent and understudied mental health problems in late life. Specific phobia, social anxiety disorder, and generalized anxiety disorder are the most prevalent anxiety disorders in older adults among the 11 disorders identified by the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Anxiety disorders lead to significant functional burdens and interface with physical health problems and cognitive impairment, concerns frequently experienced in adults over age 65. Additional contextual factors should be considered when assessing and treating late-life anxiety, including the effects of polypharmacy, other mental health conditions, role changes, and societal attitudes toward aging. The relationship between anxiety and physical health problems in older adults can be causal or contextual, and can involve poorer estimates of subjective health and lower ratings of functioning. These factors present unique challenges to the detection, conceptualization, and treatment of late-life anxiety, including the tendency for older adults to focus on somatic symptoms and the potential for long-term behaviors that can mask distress such as substance use. Researchers are increasingly incorporating a gerodiversity framework to understand the contributions of cultural, individual, and other group differences that may affect the presentation of anxiety symptoms and disorders. Older adults in general are less likely to be treated for anxiety disorders, and intersecting individual and group differences likely further affect how anxiety disorders are perceived by healthcare providers. Cognitive behavioral therapy and its variants have the most empirical support for treatment. Newer evidence lends support to acceptance and commitment therapy and problem-solving therapy, which tend to address some of the contextual factors that may be important in treatment.
Article
Brain Basis of Blindsight
Holly Bridge
The sensation of vision arises from the detection of photons of light at the eye, but in order to produce the percept of the world, extensive regions of the brain are required to process the visual information. The majority of information entering the brain via the optic nerve from the eye projects via the lateral geniculate nucleus (LGN) of the thalamus to the primary visual cortex, the largest visual area, having been reorganized such that one side of the brain represents one side of the world.
Damage to the primary visual cortex in one hemisphere therefore leads to a loss of conscious vision on the opposite side of the world, known as hemianopia. Despite this cortical blindness, many patients are still able to detect visual stimuli that are presented in the blind region if forced to guess whether a stimulus is present or absent. This is known as “blindsight.” For patients to gain any information (conscious or unconscious) about the visual world, the input from the eye must be processed by the brain. Indeed, there is considerable evidence from functional brain imaging that several visual areas continue to respond to visual stimuli presented within the blind region, even when the patient is unaware of the stimulus. Furthermore, the use of diffusion imaging allows the microstructure of white matter pathways within the visual system to be examined to see whether they are damaged or intact. By comparing patients who have hemianopia with and without blindsight it is possible to determine the pathways that are linked to blindsight function. Through understanding the brain areas and pathways that underlie blindsight in humans and non-human primates, the aim is to use modern neuroscience to guide rehabilitation programs for use after stroke.
Article
Capacity Assessment Across Functional Domains in Later Life
Benjamin T. Mast and Diana DiGasbarro
Clinicians conduct capacity evaluations to determine an older adult’s ability to make and execute a decision within key domains of functioning. Questions of capacity often arise when an older adult experiences a decline in cognitive functioning due to Alzheimer’s disease, stroke, or severe psychiatric illness, for example. Capacity is related to legal competency, and a lack of capacity may be proved by providing evidence that an older adult is unable to understand the act or decision in question; appreciate the context and consequences of the decision or act; reason about the potential harms and benefits; or express a choice. Capacity is domain-specific, time-specific, and decision-specific. Domains include financial capacity, medical treatment and research consent capacity, driving capacity, sexual consent capacity, and voting capacity. Each capacity domain encompasses activities that may vary in complexity or risk, and thus require different levels of capacity. For example, within the medical treatment consent capacity domain, an older adult may lack the capacity to consent to a complicated and risky surgical procedure while retaining the capacity to consent to a routine blood draw. Clinicians determine capacity by using a combination of tools including capacity assessment instruments, task-specific functional evaluations, interviews with the patient and family members, measures of cognitive functioning, and consideration of social, physical, and mental health factors. Extensive research has been conducted to determine the reliability and validity of a variety of capacity assessment instruments for many domains. These instruments generally assess the patient’s responses to vignettes pertaining to the domain in question, information gleaned from structured and semi-structured interviews, functional ability, or a combination of these methods. Although there is still need for more research, especially in emerging domains, capacity assessments help to protect vulnerable older adults from harm while allowing them to retain the highest possible level of autonomy.
Article
Caregiving Issues for Older Adults
Andres Losada
Caring for an older adult who needs help or supervision is in many cases associated with mental and physical health issues, especially if the care recipient has dementia, although positive consequences associated with caregiving have also been reported. Several theoretical models have shown the relevance of psychological variables for understanding variations in the stress process associated with caregiving and how interventions may benefit from psychological techniques and procedures.
Since the 1990s it has been witnessed an increment in the number of studies aimed at analyzing caregiver health and developing and testing interventions for decreasing caregiver distress. Several examples of interventions for helping caregivers are considered empirically supported, including interventions for ethnically and culturally diverse caregivers, with psychotherapeutic and psychoeducational interventions showing strong effect sizes. However, efforts are still needed to maintain the results of the interventions in the long term and to make the interventions accessible (e.g., through technological resources) to a large number of caregivers who, because of time-pressure issues associated with caregiving or a lack of support, are not benefiting from them. Making these interventions available in routine healthcare settings would help a large population in need that presents with high levels of psychological suffering.
Article
Clinical Training Concerns in Mental Health Service Provision to Older Persons
M. Lindsey Jacobs and Patricia M. Bamonti
The field of geropsychology has grown worldwide since the 1990s, particularly in the United States. In the early 21st century, professional geropsychology was recognized by the American Psychological Association as a clinical specialty. Despite this growth, there is a shortage of practicing psychologists proficient in geropsychology to meet the mental health needs of older adults. Moreover, the need for psychologists with geriatric training is continuing to grow as healthcare increasingly shifts to integrated care, creating a demand for psychologists in clinical settings such as nursing homes, hospice and palliative care, primary care, and home-based primary care. The widening gap between supply and demand requires strategic recruitment and educational initiatives to grow the number of providers with competency in working with older adults. Recruitment strategies emphasize increasing supply by “priming the pipeline” through the creation of early exposure opportunities at the secondary, undergraduate, and graduate school level, strategic recruitment of underrepresented students, and expanding financial incentives for practice.
Training and education in geropsychology have advanced considerably. The Pikes Peak Model for Professional Geropsychology Training provides the structure to gauge competency development. A framework for obtaining competency at the generalist, generalist with proficiency, and specialist levels has been created. In future years, there will be greater demand for post-licensure training in geropsychology, and geropsychologists will increasingly function as clinical educators. Technological advances will play a vital role in disseminating geropsychology education to generalist providers and related disciplines interested in gaining geropsychology exposure.
Article
Cognitive–Behavioral Theory in Sport and Performance Psychology
Faye F. Didymus
The cognitive–behavioral model of psychotherapy holds cognition at the core of psychological problems and disorders. The theoretical foundations of this model imply that dysfunctional thinking is common to all psychiatric disorders, psychological problems, and medical problems with a psychological component, and that changing an individual’s cognition results in causal changes in emotions and behaviors. In addition, when working with the cognitive–behavioral model, practitioners acknowledge that ongoing cognitive formulation is the basis of effective practice; that working with an individual’s beliefs about themselves, the world, and others results in sustained change; and that neurobiological changes occur following cognitive–behavioral therapy (CBT). The cognitive–behavioral model has been successfully applied in many domains (e.g., clinical, occupational, and sport psychology) where interventions are framed around the beliefs that characterize a presenting issue. Cognitive restructuring is one technique for implementing CBT that has been applied in sport and performance psychology. This technique is particularly relevant to performance domains because of the focus on cognitive formulation; the underpinning associations between cognition, emotion, and behavior; and the links between positively valenced emotions and superlative performance. Findings of sport psychology research extend the application of CBT beyond clinical populations and highlight the usefulness of cognitive–behavioral approaches for optimizing experiences of and performance in sport.
Some would argue that the first scientifically testable paradigm that was built on the cognitive–behavioral model of psychotherapy, and came chronologically slightly before CBT, is rational emotive behavior theory (REBT). Because both CBT and REBT share cognitive–behavioral roots, they have many similarities in their underpinning assumptions and in the ways that they are applied. REBT, however, focuses on rational and irrational beliefs and the links between an individual’s beliefs and his or her emotions and performance. REBT has a more philosophical focus with motivational theoretical roots when compared to other CBT approaches. Distinguishing features of REBT also lie in the techniques used and, hence, the way in which the underlying principles of the cognitive–behavioral model are applied. Disputing is the applied foundation of REBT and is a method of questioning an individual’s beliefs that generate emotional responses. This technique aims to help an individual recognize and adjust flaws in his or her thinking to work toward a more functional philosophy. Research that has used REBT in sport and performance contexts is sparse but that which does exist highlights the approach as a promising one for optimizing athletes’ beliefs and their emotional, behavioral, and physiological responses.
Article
Cognitive Behavioral Therapy for Anxiety
Michelle L. Moulds, Jessica R. Grisham, and Bronwyn M. Graham
Cognitive behavioral therapy (CBT) is an evidence-based, structured, goal-oriented, time-limited intervention for psychological disorders. CBT integrates behavioral and cognitive principles and therapeutic strategies; practitioners and clients work collaboratively to identify patterns of behaving and thinking that contribute to the persistence of symptoms, with the goal of replacing them with more adaptive alternatives. In the treatment of anxiety problems, the primary focus of CBT is on reducing avoidance of feared stimuli (e.g., spiders) or situations (e.g., public speaking) and modifying biases in thinking (e.g., the tendency to interpret benign situations as threatening). At its broadest, CBT is an umbrella term; it describes a range of interventions targeting cognitive and behavioral processes—ranging from early, traditional CBT protocols to more recently developed approaches (e.g., mindfulness-based cognitive therapy). CBT protocols have been developed for the full range of anxiety disorders, and a strong evidence base supports their efficacy.
Article
Common Factors in Psychotherapy
Julia Browne, Corinne Cather, and Kim T. Mueser
Common factors, or characteristics that are present across psychotherapies, have long been considered important to fostering positive psychotherapy outcomes. The contextual model offers an overarching theoretical framework for how common factors facilitate therapeutic change. Specifically, this model posits that improvements occur through three primary pathways: (a) the real relationship, (b) expectations, and (c) specific ingredients. The most-well-studied common factors, which also are described within the contextual model, include the therapeutic alliance, therapist empathy, positive regard, genuineness, and client expectations. Empirical studies have demonstrated that a strong therapeutic alliance, higher ratings of therapist empathy, positive regard, genuineness, and more favorable outcome expectations are related to improved treatment outcomes. Yet, the long-standing debate continues regarding whether psychotherapy outcomes are most heavily determined by these common factors or by factors specific to the type of therapy used. There have been calls for an integration of the two perspectives and a shift toward evaluating mechanisms as a way to move the field forward. Nonetheless, the common factors are valuable in treatment delivery and should be a focus in delivering psychotherapy.
Article
Comorbidities of Physical and Psychiatric Syndromes in Later Life
Lydia K. Manning, Lauren M. Bouchard, and James L. Flanagan
There is a great deal of concern about the increasing number of older adults who suffer from chronic disease. These conditions result in persistent health consequences and have an ongoing and long-term negative impact on people and their quality of life. Furthermore, the probability that a person will experience the onset of multiple chronic conditions, known as comorbidities, increases with age. Despite the prevalence of comorbidity in later life, scant research exists regarding specific patterns of disease and the co-occurrence and complex interactions of the chronic conditions most closely associated with aging. It is important to review the body of literature on comorbidities associated with physical and psychiatric syndromes in later life to gain an overview of some of the most commonly seen disorders in older adults: hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, arthritis, depression, and dementia. Specific patterns of disease and the co-occurrence and complex interactions of chronic conditions in later life are explored. In conclusion, we consider the need for a more informed understanding of comorbidity, as well as a related plan for addressing it.
Article
Competency to Stand Trial in the American Legal System
Ronald Roesch
Competency to stand trial is a long-established legal principle in the U.S. criminal justice system that ensures that a criminal defendant’s right to a fair trial is protected. Fundamental justice requires that criminal defendants should be able to understand the charges against them, appreciate the nature and range of penalties, and communicate with their attorney. If they do not have the capacity in any of these areas, they may be found incompetent to proceed and the judicial proceedings are suspended until they are treated and competency is restored.
While competency to stand trial is the most commonly used term, competency in the criminal trial process encompasses all stages of participation in the legal process, including pretrial, trial, sentencing, and appeals. It is also a consideration if a defendant chooses to represent him or herself. Indeed, the term itself is misleading because few defendants actually go to trial, as the vast majority of cases are resolved through plea bargaining. The competency issue is raised when an officer of the court (defense, prosecution, or judge) has reason to believe there is a bona fide doubt as to a defendant’s competence. Once raised, defendants are typically referred for an evaluation by a mental health professional. Legal precedence has established that the basis of a finding of incompetency must be the presence of a major mental illness or substantial cognitive deficit. However, the mere presence of either of these conditions is not sufficient, as a functional approach to assessing competency dictates that the mental illness or cognitive deficit must be shown to affect the defendant’s specific legal competencies. It is entirely possible, for example, that some defendants with a psychosis or other severe mental illness may nevertheless be able to proceed with their case if the mental illness does not impair the legal abilities necessary to go forward.
Article
Depression Among Athletes and the Potential Impact on Performance
Zella Moore, Jamie Leboff, and Kehana Bonagura
Major depressive disorder, dysthymia, and bipolar disorder are very common diagnoses seen among athletes, and they are serious conditions that can be debilitating if not properly addressed. These disorders warrant careful attention because they can adversely affect multiple domains of an athlete’s life, including athletic motivation, performance outcomes, interpersonal well-being, health, and overall daily functioning. Key foci include the prevalence of, clinical characteristics of, causes of, and risk factors for major depressive disorder, persistent depressive disorder/dysthymia, bipolar I disorder, and bipolar II disorder. Sport psychologists should integrate such important information into their overall case conceptualization and decision-making processes to ensure that athletes and performers at risk for, or struggling with, such mental health concerns receive the most effective, efficient, and timely care possible.
Article
Early Psychosocial Interventions for Individuals and Groups Affected by Disasters
Noreen Tehrani
Throughout the world, individuals, groups, and communities are faced with major incidents, crises, and disasters. The impact of disasters can be wide-ranging, involving death, severe injury, the loss of home, shelter, liberty, security, and food, in addition to social dislocation and destroyed infrastructure and networks. Victims can experience distress, anger, grief, and fear together with symptoms of anxiety, depression, and post-traumatic stress. First responders and those delivering longer-term social and psychological support can be adversely affected by direct exposure to the disaster, by learning about the details of the disaster from the testimony of victims, or by viewing distressing images or artifacts connected to the disaster.
To reduce the impact of disasters, communities and emergency services need to prepare plans to meet the physical, social, and psychological needs of those involved and undertake thorough testing of these plans to ensure they are fit for purpose. This planning needs to consider natural hazards such as forest fires, floods, drought, and biological hazards, including Covid-19, influenza, foot and mouth disease, and severe acute respiratory syndrome. Human and technological failings can also create hazards seen in transport crashes, the release of toxic substances, and armed conflict.
Contingency planning is used to reduce exposure to a hazard by identifying and protecting those at most risk of harm. However, it is impossible to prevent crises and disasters from happening, making it essential to provide appropriate and timely support. Initial support ensures that disaster survivors are taken to a safe place where their immediate needs for food, drinks, and shelter are met.
The aim of early psychosocial responses to disasters are fourfold: (a) to increase disaster preparedness to reduce the impact of hazards and vulnerabilities, (b) to respond to the immediate human needs for safety and survival, (c) to communicate care and provide psychological support, and (d) to provide an opportunity for survivors to process and create meaning from experiences.
Ideally, all early psychosocial interventions would be evidence-based and delivered by trained and monitored practitioners; however, often, this is not the case. Despite the development of an abundance of disaster-related models, few have been evaluated; this failure is due to a lack of agreement on the aims, scope, measures, and training required to deliver evidence-based interventions. Humanitarian and emergency response organizations look toward psychologists to provide them with the evidence-based interventions, evaluation tools, and guidance they need for dealing with disasters.
Article
Evidence-Based Psychotherapies
Alan E. Kazdin
Research in psychotherapy has developed a number of treatments, numbering well over 300, that have a strong evidence base. These treatments can be applied to a broad range of psychiatric disorders (e.g., depression, anxiety, schizophrenia, and others) as well as other sources of impairment in psychological functioning among children, adolescents, and adults. This article provides an overview of evidence-based psychotherapies, including current advances in how treatments are applied. Examples of treatments for depression and autism spectrum disorder are provided to illustrate the diversity of procedures in use and how they are applied. Key challenges related to evidence-based psychotherapies are highlighted, and these include disseminating the research findings, so that effective treatments are being used in clinical practice, and devising novel ways of delivering treatment to reach the large number of individuals who are in need of psychological services but do not yet receive care.
Article
Family Systems Therapy
Sara Honn Qualls and Lacey Edwards
Family systems therapy seeks to alter the structure or processes of a family for the purposes of reducing distress in one or more persons and improving the ability of the family to meet members’ needs. Building from a general systems paradigm, family systems therapy recognizes that family structures shift over time as they respond to members’ developmental processes and broader system demands. As members enter and exit or change capacity, and as external stressors arise, the family typically uses adaptive processes to demonstrate resilience. Family systems therapy is useful when the family struggles to adapt, or the adaptation strategy further stresses the family.
Multiple models of family systems therapies offer variations in intervention approaches but have common tenets. Major models include Ackerman’s early psychodynamics model, transgenerational models of family therapy, structural family therapy, strategic family therapy, and communications approaches to family therapy. Models vary in their recommended roles for the therapist, strategies for therapist and family, and the salience of immediate versus longer-term goals. Family systems therapies conceptualize family interactions as complex, reciprocal, open, self-organizing, adaptive, social constructionist, and meaning-making.
Family systems therapy also can be used with systems larger than families, such as schools or organizations, or to understand cultural phenomena. The field of marriage and family therapy has defined competencies for practice, training requirements, and licensure standards and established national and international professional organizations.
Article
Grief Therapy
Robert A. Neimeyer and Melissa A. Smigelsky
Death and loss are universal human experiences, yet understandings of and attitudes toward expressing grief have shifted across time. The earliest psychological conceptualization of grief pathologized “holding on” to the lost object, a notion that has since been rejected in favor of a conception of continuing bonds that can be adaptive in grief. Similarly, early stage theories of grieving suggested a linear progression toward resolution and acceptance of loss, which has been criticized in favor of approaches that allow for natural regulatory processes of attending to the loss and reengaging with a changed world. In sum, grief is no longer regarded solely as looking back on a past life with the deceased but rather is oriented toward creating and reconstructing a meaningful present and future that accommodate the loss and its impact.
Most people respond adaptively to loss by relying on their internal and social support systems. However, a significant subset of grievers struggles with complicated grief, which is characterized by intense longing for the deceased, causes impairment in various life domains, and extends beyond the period of grieving that is considered normal for the population and culture. Grief therapy is most appropriate and advantageous for grievers who self-identify the need for additional support, and this tends to happen among those who are struggling disproportionately. Complicated grief shares features with other common psychiatric diagnoses (e.g., Major Depressive Disorder and Posttraumatic Stress Disorder), as well as being characterized by distinctive separation distress regarding the deceased. Treatment for complicated grief targets the common symptoms among these disorders as well as the grief-specific manifestations of distress that are concentrated on issues of coping, attachment, meaning, and behavior.
Article
Habit Formation and Behavior Change
Benjamin Gardner and Amanda L. Rebar
Within psychology, the term habit refers to a process whereby contexts prompt action automatically, through activation of mental context–action associations learned through prior performances. Habitual behavior is regulated by an impulsive process, and so can be elicited with minimal cognitive effort, awareness, control, or intention. When an initially goal-directed behavior becomes habitual, action initiation transfers from conscious motivational processes to context-cued impulse-driven mechanisms. Regulation of action becomes detached from motivational or volitional control. Upon encountering the associated context, the urge to enact the habitual behavior is spontaneously triggered and alternative behavioral responses become less cognitively accessible.
By virtue of its cue-dependent automatic nature, theory proposes that habit strength will predict the likelihood of enactment of habitual behavior, and that strong habitual tendencies will tend to dominate over motivational tendencies. Support for these effects has been found for many health-related behaviors, such as healthy eating, physical activity, and medication adherence. This has stimulated interest in habit formation as a behavior change mechanism: It has been argued that adding habit formation components into behavior change interventions should shield new behaviors against motivational lapses, making them more sustainable in the long-term. Interventions based on the habit-formation model differ from non-habit-based interventions in that they include elements that promote reliable context-dependent repetition of the target behavior, with the aim of establishing learned context–action associations that manifest in automatically cued behavioral responses. Interventions may also seek to harness these processes to displace an existing “bad” habit with a “good” habit.
Research around the application of habit formation to health behavior change interventions is reviewed, drawn from two sources: extant theory and evidence regarding how habit forms, and previous interventions that have used habit formation principles and techniques to change behavior. Behavior change techniques that may facilitate movement through discrete phases in the habit formation trajectory are highlighted, and techniques that have been used in previous interventions are explored based on a habit formation framework. Although these interventions have mostly shown promising effects on behavior, the unique impact on behavior of habit-focused components and the longevity of such effects are not yet known. As an intervention strategy, habit formation has been shown to be acceptable to intervention recipients, who report that through repetition, behaviors gradually become routinized. Whether habit formation interventions truly offer a route to long-lasting behavior change, however, remains unclear.
Article
History of Evidence-Based Practice
Scott O. Lilienfeld and Candice Basterfield
Evidence-based therapies stemmed from the movement toward evidence-based medicine, and later, evidence-based practice (EBP) in psychology and allied fields. EBP reflects a progressive historical shift from naïve empiricism, which is based on raw and untutored observations of patient change, to systematic empiricism, which refines and hones such observations with the aid of systematic research techniques. EBP traces its roots in part to the development of methods of randomization in the early 20th century. In American psychology, EBP has traditionally been conceptualized as a three-legged stool comprising high-quality treatment outcome evidence, clinical expertise, and patient preferences and values. The research leg of the stool is typically operationalized in terms of a hierarchy of evidentiary certainty, with randomized controlled trials and meta-analyses of such trials toward the apex. The most influential operationalization of the EBP research leg is the effort to identify empirically supported treatments, which are psychotherapies that have been demonstrated to work for specific psychological conditions. Still, EBP remains scientifically controversial in many quarters, and some critics have maintained that the research base underpinning it is less compelling than claimed by its proponents.
Article
Home-Based Care and Primary Care Settings for Delivery of Geropsychology Services to Older Persons
Srijana Shrestha
Despite high rates of mental illnesses, older adults face multiple barriers in accessing mental health care. Primary care clinics, and home- and community-based senior-serving agencies are settings where older adults routinely receive medical care and social services. Therefore, integration of mental health care with existing service delivery systems can improve access to mental health services and reduce the unmet mental health needs of seniors. Evidence suggests that with innovative components mental health provided in collaboration with primary care providers with or without co-location within primary care clinics can improve depression and anxiety. Home-based models for depression care are also effective, but more research is needed in examining home-based approaches in late-life anxiety treatment. It is noteworthy that integrative models are particularly helpful in expanding the reach in underserved communities: elders from minority and low-income backgrounds and homebound seniors.
Article
Influence of Anxiety on Cognitive Control Processes
DeMond M. Grant and Evan J. White
Cognitive control is the ability to direct attention and cognitive resources toward achieving one’s goals. However, research indicates that anxiety biases multiple cognitive processes, including cognitive control. This occurs in part because anxiety leads to excessive processing of threatening stimuli at the expense of ongoing activities. This enhanced processing of threat interferes with several cognitive processes, which includes how individuals view and respond to their environment. Specifically, research indicates that anxious individuals devote their attention toward threat when considering both early, automatic processes and later, sustained attention. In addition, anxiety has negative effects on working memory, which involves the ability to hold and manipulate information in one’s consciousness. Anxiety has been found to decrease the resources necessary for effective working memory performance, as well as increase the likelihood of negative information entering working memory. Finally, anxiety is characterized by focusing excessive attention on mistakes, and there is also a reduction in the cognitive control resources necessary to correct behavior. Enhancing our knowledge of how anxiety affects cognitive control has broad implications for understanding the development of anxiety disorders, as well as emerging treatments for these conditions.
